Provider Demographics
NPI:1407205313
Name:HEALTHY CHOICES WELLNESS CENTER INC
Entity Type:Organization
Organization Name:HEALTHY CHOICES WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DE LA BRUERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-658-6022
Mailing Address - Street 1:18151 SE HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-8764
Mailing Address - Country:US
Mailing Address - Phone:503-658-6022
Mailing Address - Fax:503-658-7818
Practice Address - Street 1:18151 SE HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-8764
Practice Address - Country:US
Practice Address - Phone:503-658-6022
Practice Address - Fax:503-658-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15031261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care